Outline

Despite radical surgery prognosis of pancreatic carcinoma remains poor. Adjuvant chemotherapy shows slight improvement, but still median survival in stage I and II does not exceed 20 month. In metastasized stage IV, palliative systemic chemotherapy remains the only choice. Recent studies show higher response rates, if bevacizumab and/or erlotinib are added. But still, median survival remains as short as 6.4 month for the combination of gemcitabine/erlotinib. Locally advanced pancreatic carcinoma (T3-4, N0-1, cM0) may benefit from combined chemo-/radiotherapy.The presented data are derived from a retrospective analysis including 28 patients treated consecutively from 1999 until 2003 in a large community hospital. Radical surgery could not be performed due to infiltration of mesenteric root or encasement of mesenteric or portal vene.Combined chemo-/radiotherapy was offered to achieve good local tumour control. Therapy included weekly administration offolinic acid,high-dose fluorouracil (1.250 mg/mÂ² 24h c.i.v., d1) and mitomycin (2,5 mg/mÂ² 24h c.i.v., d2) with concurrent radiaton of the tumour region (45-50 Gy, 1,8 Gy/d). Median age was 64 yrs. Tumour stages are distributed as follows: T3N0 (7), T3N1 (11), T4N0 (3),T4N1 (7). Almost all patients presented with stable disease (26/28) at the end of combination therapy, an objective response was seen in only 2 patients (partial response rate 7%). Four patients underwent explorative laparotomy, in threepatients complete resection of the formerly inoperable tumour could be acchieved. Combined treatment resultedin median time to progression of 7 month. In most patients,the primary site of relapse was hepaticor peritoneal metastasis. Median survival was notably long with 13,8 month. From those, who underwent explorative laparotomy and complete tumor resection, two patientsare alive and still in complete remission 4+ and 5+ years after first diagnosis. Conclusion: Despite low objective response rates after combined chemo-/radiotherapy, this treatment stategy achieves impressive median survival times. In a small proportion of patientssecondary complete tumour resection was performed. Combined chemo-/radiotherapy with mitomycin, folinic acid,fluorouracil and 45 Gy radiation of the tumour region seems to be afeasable treatment option forlocally advanced pancreatic carcinoma preserving all resources of systemic palliative treatment for the later stage of metastasis.